Provider Demographics
NPI:1528293396
Name:OATES, TAWANDA
Entity type:Individual
Prefix:
First Name:TAWANDA
Middle Name:
Last Name:OATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 LOS ALTOS WAY
Mailing Address - Street 2:APT 103
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3285
Mailing Address - Country:US
Mailing Address - Phone:703-626-2469
Mailing Address - Fax:
Practice Address - Street 1:444 LOS ALTOS WAY
Practice Address - Street 2:APT 103
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3285
Practice Address - Country:US
Practice Address - Phone:703-626-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor